OBJECTIVES: To assess management choices in patients who undergo magnetic resonance imaging (MRI)/ultrasound (MRI/US) fusion-guided prostate biopsy compared to patients who undergo systematic biopsy. METHODS: We compared men who underwent MRI/US fusion-guided prostate biopsy to those who underwent systematic 12-core biopsy from 2014 to 2016. Patient demographics and pathologic findings were reviewed. The highest grade group per case was considered for analysis. RESULTS: Follow-up was available on 133 patients who underwent MRI/US targeted biopsy and 215 patients who underwent systematic biopsy...

PURPOSE: Multiparametric MRI (mpMRI) and biopsy-based molecular tests such as the 17-gene Oncotype DX® Genomic Prostate Score™ (GPS) assay are increasingly used to improve risk stratification in men with clinically localized prostate cancer (PCa). The GPS assay was previously shown to be a significant independent predictor of adverse pathology (AP) at radical prostatectomy (RP) in men diagnosed with systematic biopsies only. We therefore investigated the ability of GPS to predict AP in the setting of MRI-guided prostate biopsy...

PURPOSE: To determine the association between multiple regions of interest (ROI) on pre-biopsy magnetic resonance imaging (MRI) and the detection of clinically significant prostate cancer (CSPC) in men undergoing MRI ultrasound fusion biopsy (Fbx). METHODS: We performed a retrospective, single-institution analysis of men who underwent fusion biopsy. Men with prior positive biopsies, MRIs performed at outside institutions and MRIs prior to release of Prostate Imaging Reporting and Data System (PI-RADS) version 2 were excluded, resulting in 381 subjects...

PURPOSE: Since January 2015, all men referred to urologists in Norway due to elevated PSA or other suspicion of prostate cancer underwent multiparametric MRI (mpMRI) before prostate biopsy. At our hospital, patients and the initial MRI were assessed by an urologist and if deemed necessary, patients were referred to another institution for MR/US fusion biopsies. Before MR/US biopsy, patients underwent a second mpMRI. Since we noticed disagreement of these two mpMRIs before biopsy, we retrospectively assessed the level of agreement between the two mpMRIs from the two institutions...

PURPOSE: The aim of this study was to assess the impact of a structured reporting template on adherence to the Prostate Imaging Reporting and Data System (PI-RADS) version 2 lexicon and on the diagnostic performance of prostate MRI to detect clinically significant prostate cancer (CS-PCa). METHODS: An imaging database was searched for consecutive patients who underwent prostate MRI followed by MRI-ultrasound fusion biopsy from October 2015 through October 2017. The initial MRI reporting template used included only subheadings...

OBJECTIVE: The purpose of this study was to determine imaging and clinical features associated with Prostate Imaging Reporting and Data System (PI-RADS) category 5 lesions identified prospectively at multiparametric MRI (mpMRI) that were found benign at MRI-ultrasound fusion targeted biopsy. MATERIALS AND METHODS: Between January 2015 and July 2016, 325 men underwent prostate mpMRI followed by MRI-ultrasound fusion targeted biopsy of 420 lesions prospectively identified and assessed with PI-RADS version 2...

BACKGROUND: Radiomic analysis is defined as computationally extracting features from radiographic images for quantitatively characterizing disease patterns. There has been recent interest in examining the use of MRI for identifying prostate cancer (PCa) aggressiveness in patients on active surveillance (AS). PURPOSE: To evaluate the performance of MRI-based radiomic features in identifying the presence or absence of clinically significant PCa in AS patients. STUDY TYPE: Retrospective...

The trend towards precision-based therapeutic approaches dictated by molecular alterations offers substantial promise for men with metastatic castration resistant prostate cancer (mCRPC). However, current approaches for molecular characterization are primarily tissue based, necessitating serial biopsies to understand changes over time and are limited by the challenges inherent to extracting genomic material from predominantly bone metastases. Therefore, a circulating tumor cell (CTC)-based assay was developed to determine gene expression across a panel of clinically relevant and potentially actionable prostate cancer related genes...

PURPOSE: Image-guided systems that fuse magnetic resonance imaging (MRI) with three-dimensional (3D) ultrasound (US) images for performing targeted prostate needle biopsy and minimally-invasive treatments for prostate cancer are of increasing clinical interest. To date, a wide range of different accuracy estimation procedures and error metrics have been reported, which makes comparing the performance of different systems difficult. METHODS: A set of 9 measures are presented to assess the accuracy of MRI-US image registration, needle positioning, needle guidance, and overall system error, with the aim of providing a methodology for estimating the accuracy of instrument placement using a MR/US-guided transperineal approach...

PURPOSE: To assess the effect on reader performance of an interactive case-based online tutorial for prostate magnetic resonance imaging (MRI) interpretation using Prostate Imaging and Reporting Data System (PI-RADS). METHODS: An educational website was developed incorporating scrollable multiparametric prostate MRI examinations with annotated solutions based on PI-RADS version 2. Three second-year radiology residents evaluated a separate set of 60 prostate MRI examinations both before and after review of the online case material, identifying and scoring dominant lesions...

Conventional ultrasound-guided prostate biopsies have multiple limitations leading to underdetection of clinically significant prostate cancer (PCa) and overdetection of clinically insignificant PCa. Multiparametric MR imaging of the prostate offers better localization of prostatic tumors in comparison with ultrasound imaging and can help address these limitations. MR imaging-identified lesions can be targeted for biopsy directly in-gantry or indirectly using a fusion of MR imaging and ultrasound imaging. The fusion may be performed by the operator visually or using a software fusion device...

PURPOSE: The aim of this study was to compare biopsy detection of intraductal (IDC) and cribriform (CR) pattern invasive prostate carcinoma (PCa) in mpMRI positive and negative regions of the prostate. MATERIAL AND METHODS: A prospectively maintained single institution database was queried to identify patients who underwent mpMRI/US fusion targeted biopsy (MRI-TBx) and concurrent systematic sextant biopsy of MRI negative regions (SMN-Bx) between January 2013 and May 2016...

OBJECTIVE: To determine how best to use MRI and targeted MR/ultrasound fusion biopsy for early detection of prostate cancer in men with elevated PSA and whether it can be cost-effective. METHODS: A Markov model of prostate cancer onset and progression was developed to estimate health and economic consequences of prostate cancer screening with MRI. Men were screened with prostate-specific antigen (PSA) from ages 55 to 69. Men with elevated PSA (>4 ng/mL) received an MRI, followed by targeted fusion or combined (standard + targeted fusion) biopsy on positive MRI, and standard or no biopsy on negative MRI...